In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete fractional flow reserve (FFR)-guided revascularization does not affect final infarct size, left ventricular (LV) function, or remodeling compared with culprit-only percutaneous coronary intervention (PCI), according to study results published in JACC: Cardiovascular Interventions.
The study included participants with STEMI and multivessel disease from the Third Danish Trial in Acute Myocardial Infarction (DANAMI-3)-Primary PCI in Patients with ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization (PRIMULTI) randomized trial. Participants were randomly assigned to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. Participants underwent cardiac magnetic resonance imaging at baseline and at 3-month follow-up.
Of 280 participants, 136 had infarct-related revascularization and 144 had complete FRR-guided revascularization.
The results indicated that participants who had infarct-related revascularization had no significant differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs 11% [interquartile range, 4% to 18%]; P =.62), myocardial salvage index (median 0.71 [interquartile range, 0.54 to 0.89] vs 0.66 [interquartile range, 0.55 to 0.87]; P =.49), LV ejection fraction (mean 58±9% vs 59±9%; P =.39), and LV end-systolic volume remodeling (mean 7±22 ml vs 7±19 ml; P =.63) compared with complete FRR-guided revascularization.
The researchers found that numerically, more participants treated with complete revascularization had new non-culprit infarctions after the non-culprit intervention (6 [4.9%] vs 1 [0.8%]; P =.12).
“Because LVEF, infarct size, and LV remodeling were comparable between the treatment groups in the present study, the long-term development of heart failure is probably not affected by complete revascularization,” wrote the researchers.
Thomas Engstrøm, MD, PhD, DMSc, has received fees from Bayer, Boston Scientific, and AstraZeneca.
Kyhl K, Ahtarovski KA, Nepper-Christensen L, et al. Complete revascularization versus culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease: a DANAMI-3-PRIMULTI cardio magnetic resonance substudy. JACC Cardiovasc Interv. 2019;12(8):721-730.